inoperable - Inoperable NSCLC Controversies in Management...

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1 Controversies in Management of Inoperable NSCLC Inoperable NSCLC Introduction: It is difficult to overemphasize the magnitude of lung cancer as Public Health Problem in our society . - In US, Lung cancer accounts for 1\3 of all cancer related deaths. - More women die each year of lung cancer than breast cancer . - Lung cancer is notoriously lethal. - 85.90% of patients who develop the disease will ultimately succumb as a result . - Untreated, medium survival of patients with metastatic NSCLC is only 4-5 months with 1 year survival rate of only 10 % . The prognosis for Pts diagnosed with lung cancer remains poor. However, this disease remains a major focus of research & some exciting advances offer significant hope. Specific treatment recommendations are guided by (1) Histologic type of tumor (2) stage of disease (3) Pts Performance status The initial goal in managing Pts. with NSCLC is to determine whether a Pt. is 1. Operable : Pt. Will survive Sx with an acceptable risk 2. Cancer is resectable: Lesion is technically removable & will result in improved prognosis.
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2 Pts. Operability is usually determined by cardiovascular exam; spirometry and ABG. Resectability is determined by staging. Stage III B & IV usually do not respond to resection. For these stages a combined multimodality approach should be considered. CT Vs No CT - There have been 10 RCT comparing Platinum based CT compared with Best supportive care (BSC) includes antitussives/O 2 /analgesics/RT when indicated. - Cullen et al, 1999 (J Clin Oncol) - Other studies also showed better survival time in the treatment arm. CT N=175 (Mitomycin / Ifosfamide / Cisplatin) BSC N=176 PS=0-1 in 62% (P=0.03) 4.8 mths. 6.7 mths. Survival time - Souquet et al, 1993 (Meta - analysis of Polychemotherapy in advanced NSCLC) Lancet. ± No. of Pts : 706 ± End Point : No of Deaths at 3,6,9,12,18 months ± Conclusion : Mortality for upto 6 months. - NSCLC Collaborative Group, 1995 [CT in NSCLC, meta-analysis using updated data on individual Pts from 52 RCT] BMJ ± No. of Pts : 1190 ± Risk of Death : 27% Reduction in the risk of death in CT treated Pts. In conclusion, evidence from RCT & four separate meta-analysis support the fact that Platinum based CT improves survival in Pts. with advanced NSCLC. Do New Agents in Combination with Platinum Based Agents Improve Survival over Second-Gen. Platinum based Regimens The first of new drugs to be studied in RCT was vinorelbine. Le Chevalier T et al. (J Clin Oncol 1994) - This French study compared Cisplatin + Vindesine with Vinorelbine alone or Vinorelbine + Cisplatin.
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3 - Cisplatin/Vinorelbine had median Survival of 40 wks. Compared with cisplatin/vindesine which had 32 wks survival. -
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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inoperable - Inoperable NSCLC Controversies in Management...

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